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Quick Guide to Coagulation Testing. Marisa B. Marques and George A. Fritsma, Washington, DC: AACC Press, 2006, 62 pp., $15 ($12 AACC members), softcover. ISBN 1-59425-049-9.

University of Colorado Health, Sciences Center and Denver Health, Medical Center, Denver, CO 80204

In the past decades, significant advances have been made in understanding coagulation disorders, including thrombophilias and bleeding diatheses. Anticoagulant therapy has advanced just as rapidly, leading to the development of several new classes of drugs that may be used to treat those coagulation disorders. Our theoretical understanding of coagulopathies has been paralleled by analytical developments to help establish accurate clinical diagnoses and to aid monitoring of new therapeutic interventions.

Clinical practitioners have recognized these coagulopathies and have been administering the new anticoagulants, thus driving the need for more complex coagulation testing in clinical laboratories. Unfortunately, the clinicians’ understanding of selection and interpretation of the appropriate coagulation tests has not progressed as rapidly. The principal reason may be that diverse coagulation disorders present with only a limited number of apparently similar clinical symptoms. Often the exact diagnosis can be elucidated by test panels only, or by sequential application of multiple tests during which each subsequent test is selected based on results of the preceding analyses. The presence or absence of comorbid conditions, such as an acute illness, pregnancy, or the treatment of a coagulation disorder before the final diagnosis is established, can interfere with results of coagulation testing to the extent that correct diagnosis may not be achieved even with appropriate test selection. It is not uncommon for clinicians to be confused about ordering coagulation tests and interpreting results. At our teaching hospital we have had to resort to regularly reviewing coagulation test requisitions for appropriateness, and we routinely provide guidance in the form of consults initiated by the pathology department to guide clinicians with test selection as well as anticoagulant therapy monitoring. Cheat sheets, diagrams, and abbreviated procedures are often used in such consultations, and the need for easy access to coagulation test interpretation has become mandatory. I have been searching for a publication that can be used as a resource with such consultation, but I have been unable to find one until recently.

Quick Guide to Coagulation Testing is the right book for such a purpose. It is a spiral-bound booklet that contains only 60 small pages, and it is intended to be carried in a coat packet while making rounds or seeing patients in the clinic. It can also be used by laboratorians providing coagulation consults to clinicians. The book is divided into 7 main chapters, describing specimen collection, therapeutic ranges, reference intervals, and hemostasis and coagulation test menus as well as guidelines for thrombophilia testing, anticoagulant therapy monitoring, management of bleeding patients, and management of platelet disorders. The book has been written with a very practical purpose in mind; to provide instantaneous reference to the most commonly encountered questions in coagulation testing. Essential references are also provided at the end of the book; however, the list is not extensive. The reader should perform his or her own literature search if more in-depth references are needed.

I have found the book to fulfill its promise. It is well organized, and information is easy to locate within its covers. I was so encouraged by my initial good impressions that I decided to submit the Quick Guide to a limited, real-life trial. I have asked pathology residents to use the book in their daily practice and refer to it when they provide consultation for coagulation testing. This "trial by fire" revealed that the Quick Guide to Coagulation Testing is a convenient source of information that can expedite patient care and accelerate learning. This small volume provides information that may not be easily accessed at one place during routine clinical pathology consultations.

Even after more extended evaluations I found very few reasons to criticize this book. There are the occasional omissions such as when the text on "Hematocrit adjustment for hemostasis specimens" recommends removing sodium citrate solution from the collection tube, but does not explain how this can be done while maintaining sterility or without breaking the vacuum. Other facts that I would have liked to be included are a more detailed description of prothrombin or partial thromboplastin time mixing studies and interpretation of their results, or a table listing the various factor VIII–containing preparations that lists those also containing factor IX. These additions could have helped the reader select appropriate treatment for hemophilia A or B from a long list of similar products. On the other hand, parts of the book cover topics thoroughly, such as the short chapter on von Willebrand Disease (vWD) that includes 3 tables comparing clinical manifestations and laboratory profiles of vWD as well as expected concentrations of vWF in various ABO blood groups. Another advantage is that the book contains recommendations that are in synch with the most recent practice recommendations, such as when describing management of warfarin overdose or discussing the role of ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) testing for the diagnosis of vWD.

If I could make a wish regarding this book I would ask the authors to include in the next edition a table describing how various anticoagulants, such as warfarin and heparin, or various clinical conditions, such as recent thrombosis and pulmonary embolism, interfere with the individual coagulation tests. Further breakdown by method (such as activity assay vs genetic analysis) could be very useful to provide alternatives in clinical situations when rapid testing may be required. In my experience it is very common for a clinician who suspects a hypercoagulation disorder to order all sorts of laboratory investigations immediately after starting anticoagulant therapy, not realizing that the acute condition and therapy may render results uninterpretable. A comprehensive list of assay interferences could be very valuable in deciding whether to perform or defer testing in these circumstances.

In conclusion, I can very highly recommend the Quick Guide to Coagulation Testing to practicing clinical pathologists, pathology residents, laboratory professionals, and clinicians who see patients with coagulation disorders. Even specialists in coagulation can benefit from using this book in their everyday practice when information is needed quickly. I also feel that this book is an excellent teaching aid for faculty and should be an essential resource for residents in a clinical pathology rotation.

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